It’s that little flame
That lights a fire
Under your ass
Princeton, Avenue Q 1
We have diverse motivations to become doctors. Mine was mostly to travel, with a bit of wide-eyed idealism. Speciality training shifted this to self-preservation while weathering the pressures of registrar life. Consultant work was a forced fit of my skills into a regimented system that was too big and complex to change. The hospital team was great and the pay was amazing, but I was a long way from my initial medical motivations. With curiosity, I looked for a path that aligned with my purpose and values.
The transition from medical student to junior doctor, then senior doctor moved my perspective from “what might be” to “what should be”. Our experience creates the ability to see the change we want. Unfortunately, health systems and hierarchies usually don’t allow us to be the change we want. If this troubles you, it might be a symptom that your self-described purpose is not in sync with your actual work.
But what if your medical purpose is eclipsed by other factors? Maybe you think you’re not good enough, so idealistic aims become out of reach. Imposter syndrome, described as feelings of inadequacy despite evidence of success, is common in medicine2,3. Imposter syndrome should be regarded as a characteristic, almost cultural, element of our profession. Feeling like an imposter usually does not mean you lack competence. It is simply a predictable by-product of our working environment. It can also be a symptom of inequity4. Unfortunately, imposter syndrome paralyses our drive to think big. The “what should be” dream is flattened and we look elsewhere for purpose.
I have a nagging feeling that my specialised management plans aren’t working. I’m doing evidence-based care for a child with quadriplegic cerebral palsy, which is a core skill as a paediatric rehabilitation physician. I worked hard to learn this stuff, it should work. Out of curiosity and desperation, I’m doing a consultation at the patient’s home. It’s summer in Brisbane and it’s 30 degrees inside. The fridge door is open, displaying empty shelves. Old mattresses cover all available floor space. There is no room to push a wheelchair, so the child’s mobility aids sit on the driveway. There’s room because the family doesn’t own a car. The truth of my management failure hits home: this family’s main priority is survival. I feel embarrassed for expecting the family to organise orthotics when they struggle to afford electricity. Pushing evidence-based care is inadequate and potentially harmful for this family. Medical specialists need the community to inform their care. The flame of purpose ignites.
It's easy to adopt your organisation’s purpose. Ideally, it aligns with yours. If it doesn’t, you need to be a passive cog in the machine. Settling in and collecting your pay works well for some. It might be an excellent option if you’re managing other priorities.
But what if doctors could create jobs that aligned with their purpose?
Of course, there’s no point demanding what you want in isolation. You’ll be the only kid in the playground. If we want doctors to have a hand in designing our own jobs, we must first understand the wider system we operate in. Perhaps even reconsider if the assumed value we bring matches what society wants. We might want to manage the patient’s illness, but the patient’s main priority might be returning to work. Where is the overlap, what is unnecessary and what is crucial? What is the job to be done5?
Even though leaving the health system might seem attractive in moments of crisis, it’s a bad option. Instead, let’s give doctors at all professional levels tools to improve the system. These include diagnosing system problems, creative approaches to improvement and change management practices. This is the kindling that lights the flame and creates purpose-driven, inspired doctors.
Dr Gaj Panagoda is the founder of Xstitch Health, an emerging not-for-profit organisation that helps doctors improve community health systems. He has speciality qualifications in paediatric rehabilitation and general paediatrics. If you’re curious about creating purpose, reach out via email@example.com
1. Avenue Q: https://www.avenueq.com
2. Corkindale, G. (2008, 7 May 2008). Overcoming imposter syndrome. Harvard business review. https://hbr.org/2008/05/overcoming-imposter-syndrome
3. LaDonna, K. A., Ginsburg, S., & Watling, C. (2018). “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Academic Medicine, 93(5), 763-768. https://doi.org/10.1097/acm.0000000000002046
4. Mullangi, S., & Jagsi, R. (2019). Imposter Syndrome: Treat the Cause, Not the Symptom. JAMA, 322(5), 403-404. https://doi.org/10.1001/jama.2019.9788
5. Clayton Christensen’s landmark explanation on Understanding the Job: https://youtu.be/sfGtw2C95Ms